THORAX, PERICARDIUM: 104, 105, 107 Flashcards
What lung protdrude more cranially?
the left cranial lobe compared to the right cranial
arterial supply of the dorsolateral skin of the thorax
thoracodorsal artery
surgical access to ICS cranial to 5 (not comprised)
skin, latissimus dorsally + deep pectoralis ventrally, scalenus, (rectus toracis very ventral), serratus dorsalis+ serratus ventralis, ICS muscle
origin of the intercostal artery
the first 3-4 are branches of the thoracic vertebral artery
remainder direct brances from aorta
what vessel always accompany dorsal the transverse thoracic muscle?
internal thoracic artery (arise fromo left and right subclavian arteries)
in sternotomy closure is preferred to use a figure of eight or a double loop cerclage?
figure of 8
what breeds are predisposed to pectus excavatum?
bengala and burmese. cause of a shortened or hypoplastic diaphragm
what breeds are predisposed to pectus excavatum?
bengala and burmese. cause of a shortened or hypoplastic diaphragm
name some of the muscles that could serve as flaps in the thoracic region
latissimus dorsi, external abdominal oblique, transversus abdominis, diaphragm
surgical access caudal to ICS 5 (included)
latissimus dorsi, only a small portion ventrally of pectoralis deep. serratus dorsalis and ventralis (not until last ribs), NO scalenus, YES external abdominal oblique ventrally
physiologic content of pleural fluid in dogs and cats
dogs: 0,1 ml/kg
cats: 0,3 ml/kg
lymphatic drainage of the thorax
VISCERAL NODES:
mediastinal: cranial mediastinum, hearth surface
bronchial: pulmonary + tracheobronchial
PARIETAL NODES:
ventral center: right and left sternal (or single)
dorsal center: aortic thoracic nodes, inconsistent in dimensions and presence (25% of dogs)
cisterna chili anatomic landmarks
ventral to 1-4 lumbar vertebrae
anatomic differences in thoracic duct beetween dogs and cats
dorsolateral to aorta RIGHT in dogs, LEFT in cats. crosses to the left in dogs at 6-7 thoracic vertebra.
boths terminates in ext jugular vein or jugosubclavian angle
pleural fluid classification
trasudate: <3 PRO, <1015 PS, < 1500 NCC/microlitro
modif trasudate: 2,5-5 PRO, 1015-1025 PS: 1500-7000 NCC/microlitro
exudate: > 3 PRO, >1025 PS, >7000 NCC/microlitro
how to diagnose a chylous effusion
triglyceride effusion > triglyceride serum
cholesterol effusion < cholesterol serum
detection of chylomicrons
what is pseudochylous?
not descrubed in pets, in human medicine when cholesterol effusion> cholesterol serum and viceversa trygliceride.
frequently present bacteria in septic pleural exudate
nocardia and actinomyces. usually are more frequent anaerobes
common RX finding in a dog with lung lobe torsion
increased opacity, up to 87% have the emphisematous appearance on the malpositioned LL
thoracostomy tube placement anatomic landmarks
skin incision: 10-11 ICS, insertion 7-8 ICS
what structures can be approached with only a monolateral toracotomy?
PDA, PRAA: 4-5 LEFT
PULMONIC VALVE: 4 LEFT
MIDDLE LUNG LOBE: 5 RIGHT
CRANIAL VENA CAVA: 4 right commonly, but also 4 left
THORACIC DUCT: 8-9-10-11 right dog, left feline.
what structures can be approached with only a monolateral toracotomy?
PDA, PRAA: 4-5 LEFT
PULMONIC VALVE: 4 LEFT
MIDDLE LUNG LOBE: 5 RIGHT
CRANIAL VENA CAVA: 4 right commonly, but also 4 left
THORACIC DUCT: 8-9-10-11 right dog, left feline.
surgical access to perform a LN injection and simoultaneously thoracic duct ligation
right lateral paracostal (LN) + right ICS
surgical access to perform a LN injection and simoultaneously thoracic duct ligation
right lateral paracostal (LN) + right ICS
reported percentage of success with pericardiectomy+thoracic duct ligation
80-100%
septic effusion lactate, glucose and pH
usually lactate >200 IU/L. glucose <1,68 mmol/L, pH <6.9
time to pleural drain removal
4-8 days. usually removed when it produces less than 3-5 o less than 2 ml/Kg/day
common neurological disorder associated with tymoma in dogs
up to 47% develop myasthenia gravis
where does the pericardium attaches in the thorax?
base of the hearth (Aortic arch, brachiocephalic trunk, left atrium, interatrial groove)
caudoventral apex anchors ventrally on to muscolar insertion of the diaphragm
describe the pericardium vascular supply
-paired pericardial branches of the internal thoracic artery (course caudoventrally on LV aspect of the pericardium).
-perciardiocophrenic arteries (from internal thoracic, supply dorsolateral aspect of the pericardium
describe the sequelae of event that occurs after cardiac tamponade
1) cardiac output decrease, systemic venous pressure increase
2) activation of compensatory neurohumoral response
3) RAAS activation
4) sympatethic stimulation
5) catecholamine release
what does the NON stretching of the right atrium determine
lack of releasing of atrial natiouretic peptide. id does not counteract the action of RAAS. as a consequence there will be portal hypertensions and venous hypertension
descrive the mechanism at the base of pulsus paradoxus
1) during inspiration pericardial and right atrium pressure decrease
2) inspiration -> higher venous flow to RA
3) interventricular septum shift to the left
4) inspiration -> left hearth output and arterial pressure decrease
5) variation in systolic pressure (>10 mmHg) and pulse regarding to the phase of breathing
what patologies can cause pulsus paradoxus other than cardiac tamponade?
-restrictive cardiomiopaty
-obstructive lung desease
-hypovolemic shock
ICS space access for vena cava stricture surgery
Right sided 5-6th ICS
What is a possible fungal infection to the pericardium?
coccidioides immitis (southern USA)
most 2 frequent causes of pericardial effusion
1) idiopathic pericardial effusion
2) neoplasia (hemangio, hearth base, pericardium, chemodectoma, mesotelima)
ICS space for thoracocentesis
right (avoid main coronary arteries) 5-6 ICS
description of transdiaphragmatic subxiphoid approach
Duprè 2001
what is the kussmaul sign
persistent increase in jugular venous pressure during inspiration
